The Value of a Patient Global Assessment of Disease Activity in Granulomatosis With Polyangiitis (Wegener's)
The Value of a Patient Global Assessment of Disease Activity in Granulomatosis With Polyangiitis (Wegener's)
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DOI：
10.1002/art.38248
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发表时间：
2014-02-01
影响因子：
13.3
通讯作者：
Merkel, Peter A.
中科院分区：
文献类型：
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作者：
Tomasson, Gunnar;Davis, John C.;Merkel, Peter A.
Objective. 1）描述伴有多血管炎的肉芽肿（GPA;韦格纳氏）患者疾病活动度的患者总体评估（PtGA）评分的分布，2）探索PtGA评分与医生疾病活动度总体评估（PhGA）评分之间的不一致性，3）探索疾病缓解期间的PtGA评分是否与未来疾病复发相关。方法。使用韦格纳肉芽肿依那西普试验（WGET）的数据。采用100 mm视觉模拟量表（VAS）评估PtGA和PhGA评分。使用伯明翰血管炎活动性评分（BVAS/WG）确定活动性疾病的存在，缓解定义为BVAS/WG评分为0。疾病复发定义为在达到缓解后BVAS/WG评分>0。PtGA和PhGA评分之间的不一致性定义为两种测量之间的差异>= 20分。混合线性模型用于PtGA评分的纵向分析。数据来自WGET队列中的180名患者，共1，719次研究访视。基线时平均+/- SD PtGA和PhGA疾病活动评分（100 mm VAS）分别为64.2 +/- 27.4和55.5 +/- 23.4。在基线时，53%的患者发生PtGA-PhGA不一致，这与基线时新诊断的疾病（而不是复发性疾病）呈负相关（比值比0.37，95%置信区间[95% CI] 0.20-0.68），但与年龄、性别或存在肾脏或肺部疾病无关。在62%的研究访视期间，患者处于疾病缓解状态。复发前访视期间的平均PtGA评分比其他缓解访视时高4.52分（95%CI 0.66-8.4）（P = 0.03）。结论。PtGA-PhGA不一致在GPA中很常见。在医生定义为缓解期的时间内PtGA疾病活动性评分的升高与随后疾病复发的发生相关。这些发现支持增加PtGA作为GPA的结果指标。
Objective. To 1) describe the distribution of patient global assessment (PtGA) scores of disease activity in patients with granulomatosis with polyangiitis (GPA; Wegener's), 2) explore the discordance between PtGA scores and physician global assessment (PhGA) scores of disease activity, and 3) explore whether PtGA scores during disease remission are associated with future disease relapse.Methods. Data from the Wegener's Granulomatosis Etanercept Trial (WGET) were used. PtGA and PhGA scores were assessed on 100-mm visual analog scales (VAS). Presence of active disease was determined using the Birmingham Vasculitis Activity Score for WG (BVAS/WG), and remission was defined as a BVAS/WG score of 0. Disease relapse was defined as a BVAS/WG score of >0 after remission had been achieved. Discordance between PtGA and PhGA scores was defined as a difference of >= 20 points between the two measures. Mixed linear models were used in longitudinal analysis of PtGA scores.Results. Data were obtained from 180 patients in the WGET cohort, seen at a total of 1,719 study visits. The mean +/- SD PtGA and PhGA disease activity scores (on 100-mm VAS) at baseline were 64.2 +/- 27.4 and 55.5 +/- 23.4, respectively. PtGA-PhGA discordance occurred in 53% of patients at baseline, and this was inversely associated with newly diagnosed disease (as opposed to relapsing disease) at baseline (odds ratio 0.37, 95% confidence interval [95% CI] 0.20-0.68) but not with age, sex, or presence of renal or pulmonary disease. Patients were in disease remission during 62% of the study visits. The mean PtGA score during visits immediately prior to relapse was 4.52 points higher (95% CI 0.66-8.4) than that at other remission visits (P = 0.03).Conclusion. PtGA-PhGA discordance is common in GPA. A rise in the PtGA disease activity score during times defined by physicians as periods of remission is associated with subsequent occurrence of disease relapse. These findings support the addition of PtGA as an outcome measure for GPA.